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healthcare

Continuing Secular Students Week, I’ve got a guest post from Tim Kolanko, a student activist who was able to use the SSA’s support to bring a speaker to raise awareness of intersex issues and medical malpractice.

I’m Tim Kolanko, President of the Northern Illinois University Secular Student Alliance. A few weeks ago, the national Secular Student Alliance gave my group a grant so we could hold an awesome event, “The Gender Binary and LGBTI People: Religious Myth and Medical Malpractice.” Thanks to their funding, we were able to bring in Dr. Veronica Drantz and two intersex activists to talk about how LGBTI (Lesbian, Gay, Bisexual, Transgender, Intersex) people have been and continue to be victims of medical malpractice purely because they are neither Adams nor Eves.

Psychiatrists, surgeons, endocrinologists, pediatricians, and other medical experts have subjected LGBTI people to bogus and horrific treatments with reckless disregard for patient health and well-being―all the while ignoring the basic tenets of medical ethics and the ever-growing scientific evidence showing LGBTI people to be natural variations. This talk contrasted the scientific evidence with the ongoing medical (mis)treatment of LGBTI people to vividly illustrate the insidious effect of the biblical creation myth.

The event included an hour-long presentation of Dr. Drantz laying out the scientific evidence having to do with sexual development, sexual orientation, and gender identity, arguing that LGBTI people are natural variations. Her presentation was followed by the emotionally powerful personal testimonials of two intersex people that have been harmed by the medical community and society because they are viewed as disordered, not different.

The Project Grant we received from the Secular Student Alliance allowed us to fund not only the speakers, but the video recording of the event! With the help of two on-campus co-sponsors, we were able to put on a successful event. We worked with the my University’s Gender & Sexuality Resource Center and the Women’s, Gender, and Sexuality Studies Program.

Around 40 people took part, despite the severe weather in the area, and we were so excited to be able to network with two large on-campus organizations, which will definitely help for future events!

This event wouldn’t have been possible without the support of the national SSA. Their grant, and their support of our organization, lets us explore the world from a naturalistic point of view, combat the negative connotations associated with being non-religious, and promote critical thinking, reason, and skepticism over faith-based worldviews.

Not only did the SSA give us a grant, but they also provide us with so many free resources and services, like our tabling supplies! They are only able to do this because of the generosity of people just like you.

This week is Secular Students Week, when the SSA is highlighting activism of students like me and my group members. If they get 500 donations this week, they’ll unlock a challenge grant for $20,000!! This money would have a huge impact for groups like mine: help us out by giving today! Even a gift of $5, $10, or $20 can make a big difference: give to the SSA today!

Many debates in the realm of social justice and politics are debates about context. In what context are certain things said, and can those things ever be divorced from that context? Should they ever be?

Take this Facebook post, made by a New York coffee shop I had heretofore found entirely satisfactory:

Image description: a Facebook post by The Bean, including a photo of a NYPD police car and a caption, “Thank you NYPD for protecting our great city.”

What is so irritating about this post is the plausible deniability. Surely, a Manhattan coffee shop could just post this image apropos of nothing, perhaps in the holiday spirit, to express gratitude towards the city’s police force. It could just be a matter of city pride; certainly we all like it when there is as little crime as possible. And so on and so forth.

But why post this image now? Why would a coffee shop that has posted nothing but photos, comics, and articles about coffee, store news, six posts about local events, and one cutesy article about Mother’s Day for the entirety of the year 2014 suddenly give a shout-out to the city police department?

I think I know why. But, of course, I can only speculate.

So it is with a lot of other statements that rankle, hurt, or even trigger. “What were you wearing?” Oh, sure, you could just be curious. After all, maybe it was my outfit and not my perceived gender that drew my harasser’s attention that night. Of course, you are very worried about me and just want to make sure that I’m being “smart.” You’re not thinking about the fact that that’s often the first question authorities ask us, and that fashion advice is the only kind of prevention they seem to be able to offer us. You’re not thinking about what happens to women whose outfits were deemed insufficiently preventative. Who helps those women? “Oh, I’m not saying it’s your fault,” you say. “I think anyone who does such a thing is wrong and bad and if it were up to me I would bring them to justice.” Would you? Okay, I’ll grant you that. But historically, that’s not what’s happened, is it?

“What about black-on-black crime?” Certainly it is a tragedy that so many young Black people die at each other’s hands, presumably because of gangs or drugs or one of those other scary things, and really, if a given group wants to stop dying, maybe they should stop killing each other. Never mind that the same ignorance that causes people to ask this question is the ignorance that keeps them from seeing everything that’s already being done, by Black people, to address this issue. Never mind that most white murder victims are killed by other white people, too, because people tend to be killed by those who are near to them and/or have some sort of relationship with them, and our neighborhoods and relationships are still very segregated. Never mind that “black-on-black crime” is a derailment from what is in my opinion a much more preventable issue–the fact that police around the country are killing Black people with virtually no consequences.

Yes, violent crime happens, especially in disadvantaged areas, and that is awful. But that the people tasked with “protecting” us, according to my local coffee shop, are murdering people, especially in a systematically racist way, deserves immediate attention and resolution, because a police officer who murders innocent people is an even greater threat to our society than an ordinary citizen who murders innocent people. Why? That should be obvious: cops have power, weapons, skills, and immunity that ordinary citizens do not. Law enforcement officials can do things like plant meth in the car of a woman who accused them of sexual harassment and then have her arrested on this country’s ridiculous drug laws.

“I don’t see anything wrong with gay people, I just don’t see why they have to be in my face about it.” No, you’re right. Perhaps you are a person who believes that sex, love, and relationships should be an entirely private matter. Maybe you’re uncomfortable when your coworker tells everyone about the vacation she’s planning for her and her husband’s anniversary. Maybe it turns your stomach to see free condoms handed out on your campus. Maybe you change the channel every time a guy and a girl kiss in a TV show and you don’t feel that it’s appropriate for children to see a man and a woman holding hands in public. But you don’t mention that because…maybe people would ridicule you for it, whereas publicly stating that gay couples gross you out is still socially acceptable. I don’t know.

Or maybe you have double standards for queer people versus straight people, and you believe that the things straight people get to do–hold hands and kiss in public, chat at work about their anniversary plans, see relationships like theirs on television, access the healthcare that they need–are not things that queer people get to do. Sometimes queer people are loud and in-your-face about being queer because they are fighting against the idea that they should have to be silent when straight people don’t have to be. Your casual remarks about “I just wish they’d keep it to themselves” are telling us to get back in the closet so you don’t have to be uncomfortable.

“Of course it’s wrong to hate people just because they’re fat, but they really need to lose some weight or else they’ll be unhealthy.” You may think that what you’re saying here is commendable. After all, you must really care about this person and have great concern for their wellbeing. Maybe you even have some helpful weight loss advice that totally worked for you. Really, they should be grateful that you’re trying to help them.

Okay, but the idea that “they really need to lose some weight or else they’ll be unhealthy” is the idea that causes people to hate them in the first place. If weight is perfectly correlated to health, and if losing weight is a possibility for everyone, then only those who do not care about their health would allow themselves to be fat, and only an irresponsible person who lacks self-control would refuse to care about their health. Such a person would not make a suitable employee, doctoral student, or partner, for instance. Such a person would be a bad influence for your children. And the idea that fatness is responsible for poor health 100% of the time keeps fat people from getting the medical care they need, because doctors assume that the problem must be their weight.

Plausible deniability is how all of these statements function. We are expected to take them entirely out of context, as isolated thoughts or ideas or feelings or beliefs that have nothing to do with what came before or what will come after, and nothing to do with the horrors that have been committed in their name. You asking me what I was wearing has nothing to do with the systematic refusal to believe and help people who have been harassed and assaulted. You innocently wondering about black-on-black crime has nothing to do with centuries of white-on-black crime, and with the casual dismissal of this crime, and with the fact that it has historically not been defined as a crime at all. You wishing that queer people wouldn’t shove their sexuality in your face has nothing to do with our erasure, metaphoric and sometimes literal. You patronizingly advising bigger people to get smaller has nothing to do with their mistreatment in all sorts of social contexts, including medical ones. Nothing at all!

But that’s not how communication works. If a celebrity becomes the center of a huge controversy and I post about my love for their films or music, that can and should be taken as a statement of support for that celebrity. If a business comes under fire for its practices or policies and I post about how I’m going to proudly patronize that business today, that can and should be taken as a statement of support for that business. (In fact, I once ended a friendship with someone who did this on the day the Chick-Fil-A homophobia thing went viral, and I do not regret it.) There is of course a chance that I had simply not heard of the controversy, but in that case, I should reconsider my support for this person or business once a friend helpfully comments and lets me know about what’s going on. And in most cases people do not do this.

So if you post about your gratitude to the NYPD right after one of its officers has once again gone unpunished for the cruel killing of a Black man, and as protests march right down the block where your coffee shop stands, that has a context, too.

I suppose it can feel like this is all a huge burden. Why shouldn’t you be able to just say what you think and feel without being held responsible for decades or centuries of terrible things done in the service of the beliefs that you are expressing? It’s true that what happened is not your responsibility, and every terrible thing done by people who believe the same things you believe is not your fault.

But that is why what you say hurts people, and that is why they warn you where your beliefs may logically lead. If what women wear has any relevance to their sexual violation, if black-on-black crime is more important and urgent than white-on-black racism, if queer people being open about themselves and their loves is so unpleasant for you, if fat people should lose weight before they are taken seriously–then that has implications for how we treat people and issues. If you take the time to listen to the voices of those most affected by these issues, you might see that these implications are just as horrifying to you as they are to us.

Note: If you already know all about Ohio’s terrible new anti-abortion bill, scroll all the way to the end to find out how to try to stop it. If not, read on.

Last Tuesday night, I and–at times–150,000 other people stayed up to watch the livestream of the 12-hour filibuster in the Texas state legislature. State senator Wendy Davis and her fellow Democrats helped prevent (temporarily) the passage of what would’ve been one of the most restrictive anti-abortion bills in the country. Davis overcame exhaustion, hunger, and her Republican opponents’ bad-faith attempts to get her to go off-topic (in Texas, filibusters must remain “germane” to the bill at hand), to claim that she was breaking rules, and, when the going got tough, to cheat and try to pass the bill after the midnight deadline.

Unfortunately, Davis’ victory was only temporary, and Texas is only one of the the states where reproductive rights are constantly under assault.

My home state of Ohio (I use the word “home” loosely here) just passed House Bill 200, a bill similar to the one that got filibustered in Texas, except worse. Some of its provisionsinclude:

Doctors must explain to patients seeking abortion how their fetus’ nerves develop, and to tell them that, even in the first trimester, a fetus can feel pain. There is no scientific evidence of this.

As in the Texas bill, abortion providers in Ohio must be within 30 miles of a hospital, but here’s the new catch–it cannot be a public hospital. So if there are no non-public hospitals within 30 miles of an abortion clinic, then the clinic must shut down.

Doctors must inform patients seeking abortions exactly how much money the clinic made from abortions within the past year, and how much money the clinic stands to lose if the patient chooses not to get an abortion. In case it’s unclear, the point of this is to warn patients that there is a “conflict of interest” involved in providing abortions because clinics can make money from them. This is ridiculous because any medical procedure can make money for doctors and hospitals.

Before this bill, patients seeking abortions in Ohio were already required to view an ultrasound of the fetus. Now, the doctor must describe the fetus visually and explain the current development of its features. Although the bill doesn’t stipulate what type of ultrasound it has to be, it does require for it to produce a clear image of the entire body of the fetus, and for first-trimester patients, that probably requires an invasive transvaginal ultrasound. Victims of sexual assault are not exempt, and the patients must pay extra for the ultrasound.

The mandatory wait period for an abortion in Ohio used to be 24 hours; now it will be 48 unless there is a dire medical need to terminate the pregnancy. Again, victims of sexual assault are not exempt. While some people may claim that it shouldn’t be a big deal to have a wait a day or two, remember: restrictions like these disproportionately impact teenagers, the poor, and those who live in rural areas. For a teenager to miss school and get a ride to an abortion clinic without their parents’ knowledge is difficult enough already; doing it twice is even harder. Same for a poor person who has to skip work, and for a person living in a rural area who has to drive a long way to get to an abortion clinic (and it’ll be even longer thanks to the closures that will occur as a result of this bill). In any case, having to wait, especially having to wait a longer period of time, causes stress and anxiety. These politicians seem to be hoping that that stress and anxiety somehow dissuades the person from getting the abortion.

Before, a doctor could get a medical waiver to bypass these restrictions if the pregnancy was causing health problems. But now, doctors will only be able to get those waivers if the potential health risks are so great that the pregnant person could die. Anything less than death, apparently, is no big deal.

These abortion restrictions are like the proverbial frog in boiling water. They do it gradually–a 24-hour waiting period here, a mandatory ultrasound there. So what if doctors must have admitting privileges at nearby hospitals? Doesn’t that make abortion safer? (No.)

But before you know it, abortion is nearly or completely unavailable in a given state, and the degree to which it is unavailable varies according to how much money, status, and support you have. Those people who will be most harmed by an unplanned-for and unwanted child will also be the ones for whom abortions are hardest to access. This is unconscionable and it must stop.

Furthermore, most of these restrictions are predicated on the belief that pregnant individuals cannot be trusted to make decisions about their own bodies on their own. They need waiting periods. They need to be shown ultrasounds. They need their fetus’ development described to them. They need to be informed, as though they are completely clueless and ignorant, that doctors make money when they perform medical procedures.

Of course, the point of the bills is not to make abortion safer. This must be stressed over and over again. The point of the bills is to make abortion difficult or impossible to access. Do not fall for the Republicans’ paternalistic claptrap about how they’re just trying to keep women (they think everyone who gets an abortion is a woman) safer. They’re trying to outlaw abortion, slowly and surely.

How do I know? Many reasons, and I’ll use the very similar Texas bill as an example. Texas Republican legislator referred to opponents of the filibustered bill as “terrorists.” Texas Governor Rick Perry, defending the bill, said that “the louder the opposition screams, the more we know we’re doing something right.” (Yes, that is as rapey as it sounds.) Texas Lieutanant Governor David Dewhurst said that the protesters who prevented the bill’s passage “disrupted the Senate from protecting unborn babies.” Where’s the compassion and the concern for safeguarding women’s health now?

As I mentioned, the Ohio bill has already passed. It was included last-minute in a state budget bill, leaving reproductive rights advocates no time to organize any resistance like they did in Texas.

However, Ohio Governor John Kasich has until midnight tomorrow (Sunday) to veto any or all of the bill’s provisions. Kasich, a Republican, has said that he opposes abortion, but maybe even he will realize that this is just too much.

Here’s what you can do: call Gov. Kasich at (614) 466-3555 or email him here and let him know you oppose House Bill 200. I just did. Remember what I wrote about online activism? We can make a difference.

There’s a certain scorn reserved for people who diagnose themselves with mental illnesses–people who, based on their own research or prior knowledge, decide that there’s a decent chance they have a diagnosable disorder, even if they haven’t (yet) seen a professional about it.

I understand why psychologists and psychiatrists might find them troublesome. Nobody likes the idea of someone getting worked up over the possibility that they have a mental illness when they really don’t. Professional mental healthcare workers feel that they know more about mental illness than the general population (and, with some exceptions, they do) and that it’s their “job” to serve as gatekeepers of mental healthcare. This includes deciding who is mentally ill and who is not.

This actually bothers me much more than the arguments against self-diagnosis coming from professionals. Why?

Because the claim that people who self-diagnose are just “doing it for attention” or because they think it’s “cool” is the exact same claim frequently made about people who get diagnosed professionally.

To be clear, I’m not saying that people never label themselves as mentally ill for attention. Maybe some do. Maybe a significant proportion of people who self-diagnose don’t really have a mental illness at all. I’d have to see research to know, and from my searches so far I haven’t really found much research on the phenomenon of self-diagnosis. (But I’m taking note of this for my master’s thesis someday.)

However, there’s a difference between someone who’s feeling sad for a few days and refer to themselves as “depressed,” and someone who’s been struggling for weeks, months, or years, and who has read books and articles on the subject and studied the DSM definition of the illness. The former may not even count as “self-diagnosis,” but rather as using a clinical term colloquially–just like everyone who says “oh god this is so OCD of me” or “she’s totally schizo.” (This, by the way, is wrong; please don’t do it.)

(It’s also likely the case that some people self-diagnose because they have hypochondria. However, the problem is not that they are self-diagnosing. The problem is that they have untreated hypochondria. Maybe diagnosing themselves with something else will get them into treatment, where a perceptive psychologist will diagnose them with hypochondria and treat them for it.)

Even if some people who self-diagnose are wrong, I still think that we should refrain from judging people who self-diagnose and take their claims seriously. Here’s why.

1. It gets people into treatment.

I wish we had a system of mental healthcare–and a system of social norms–in which everyone got mental health checkups just as they get physical health checkups. For that, two main things would have to change–mental healthcare would have to become affordable and accessible for everyone, and the stigma of seeing mental health professionals (whether or not one has a mental illness) would have to disappear. (There are other necessary conditions for that, too–the distrust that many marginalized people understandably have for mental healthcare would have to be alleviated, and so on.)

For now, going to see a therapist or psychiatrist is difficult. It requires financial resources, lots of time and determination, and a certain amount of risk–what if your employer finds out? What if your friends and family find out (unless they know and support you)? What will people think?

Because the barriers to seeing a professional are often high, many people need a strong push to go see one. Having a strong suspicion that you have a diagnosable mental illness can provide that push for many people, because nobody wants to go through the hassle of finding a therapist that their insurance covers (or finding a sliding-scale one if they don’t have insurance), coming up with the money to pay the deductible, taking time off work to go to the appointment, dealing with the fear of talking to a total stranger about their feelings, and actually going through with the appointment, only to be told that there’s “nothing wrong” with them.

As much as I wish things were different, the reality right now is that relatively few people go to therapists or psychiatrists unless they believe that they have a mental illness. If self-diagnosing first gets them into treatment, then I don’t want to stigmatize self-diagnosis.

2. It helps them find resources whether or not they see a professional.

In the previous point, I explained that for many people, self-diagnosing can be a necessary first step to getting treatment from a professional. In addition, once people have diagnosed themselves, they are able to seek out their own resources–books, support groups, online forums, etc.–to help them manage their symptoms. This can be extremely helpful whether or not they’re planning on getting treatment professionally.

While psychiatric labels like “depression,” “generalized anxiety,” and “ADHD” have their drawbacks, they are often necessary for finding resources that help people understand what they’re going through and help themselves feel better. If I’m at a library looking for books that might help me, asking the librarian for “books about depression” or “books about ADHD” will be much more useful than asking them for “books about feeling like shit all the time and not wanting to do anything with friends” or “books about getting distracted whenever you start work and not really having the motivation to finish any of it and it has nothing to do with laziness by the way.” Same goes for a Google search.

It’s certainly fair to be worried that people looking on their own will find resources that are unhelpful or even dangerous. But I think this is less of a problem with self-diagnosis per se, and more of a problem with the lack of scientific literacy in our society, and the lack of emphasis on skepticism when evaluating therapeutic claims. For what it’s worth, going to see a mental health professional will not necessarily prevent you from encountering quackery and bullshit of all kinds. And in any case, the blame does not lie with the people who self-diagnose and then fall for pseudoscientific scams, but with the people who perpetrate the scams in the first place.

This point is especially important given that many people will not be able to access professional mental healthcare services for various reasons. Maybe they can’t afford it; maybe they work three jobs and don’t have time; maybe they can’t find a therapist who is willing to accept the fact that they are trans*, kinky, poly, etc. Maybe they are minors whose parents are unwilling to get them into treatment. Maybe they were abused by medical professionals and cannot go back into treatment without worsening their mental health.

There are all kinds of reasons people may be unable to go and get their diagnosis verified by a professional, and most of these are tied up in issues of privilege. If you have never had to worry that a doctor or psychologist will be prejudiced against you, then you have privilege.

3. It can help with symptom management whether you have the “real” disorder or not.

At one point when my depression was particularly bad I noticed that I had some symptoms that were very typical of borderline personality disorder. For instance, I had a huge fear that people would abandon me and I would bounce back and forth between glorifying and demonizing certain people. If someone made the slightest criticism of me or wasn’t available enough for me, I would decide that they hate me and don’t care if I live or die. I had wild mood swings. That sort of thing. It’s not that I thought I actually had BPD; rather, I noticed that I had some of its symptoms and wondered if perhaps certain techniques that help people with BPD might also help me.

Luckily, at this time I was still seeing a therapist. So in my next session, I decided to mention this observation that I had made, and the conversation went like this:

Me: I’ve noticed that I have some BPD-like symptoms.
Her: Oh, you don’t have BPD.
Me: Right, but I seem to have some of its symptoms–
Her: No, trust me, I’ve worked with people with BPD and you do NOT have BPD.

I suppose I could’ve persevered with this line of thinking, but instead I felt shut down and put in my place. I dropped the subject.

So determined was this therapist to make sure that I know which mental illness(es) I do and do not have that she missed out on what could’ve been a really useful discussion. What she could’ve done instead was ask, “What makes you say that?” and allow me to discuss the symptoms I’d noticed, whether or not they are indicative of BPD or anything else other than I am having severe problems relating to people and dealing with normal life circumstances.

The point is that sometimes it’s useful to talk about mental illness not in terms of diagnoses but in terms of symptoms. What triggers these symptoms? Which techniques help alleviate them?

So if a person looks up a mental disorder online and thinks, “Huh, this sounds a lot like me,” that realization can help them find ways to manage their symptoms whether or not those symptoms actually qualify as that mental disorder.

This is especially true because the diagnostic cut-offs for many mental illnesses are rather random. For instance, in order to have clinical depression, you must have been experiencing your symptoms for at least two weeks. What if it’s been a week and a half? In order to have anorexia nervosa, you must be at 85% or less of your expected body weight*. What if you haven’t reached that point yet? What if you don’t have the mood symptoms of depression, but you exhibit the cognitive distortions associated with it? Acknowledging that you may have one of these disorders, even if you don’t (yet) fit the full criteria, can help you find out how to manage the symptoms that you do have.

4. It helps them find solidarity with others who suffer from that mental illness.

I understand why some people with diagnosed mental illnesses feel contempt toward those who self-diagnose. But I don’t believe that sympathy and solidarity are finite resources. If someone is struggling enough that they’re looking up diagnostic criteria, they deserve support from others who have been down that path, even if their problems might not be “as bad” as the ones other people have and/or have not yet been validated by a professional.

Acknowledging that you may have depression (or any other mental illness) can help you find others who have experienced various shades of the same thing and feel like you’re not alone.

My take on self-diagnosis comes from a perspective of harm reduction. The idea is that strategies that help people feel better and prevent themselves from getting worse are something we should support, even if these strategies are not “correct” or “legitimate” and do not take place within the context of established, professional mental healthcare.

We should work to improve professional mental healthcare and increase access to it, especially for people in marginalized communities and populations. However, we should also acknowledge that sometimes people may need to help themselves outside of that framework. These people should not be getting the sort of condescension and eye-rolling they often get.

~~~
*The diagnostic criteria for eating disorders are expected to improve with the release of the new DSM-V, but I’m not sure yet whether or not the 85% body weight requirement will still be there. In any case, this is how it’s been so far.

One of the first things one learns in a college-level history or sociology course is that the ways we define and think about various human attributes and qualities—sexual orientation, mental illness, gender, race, virginity—are never static. They vary geographically and temporally, and even though it may seem that the way we currently conceptualize a particular aspect of human experience is the “right” one, the one that’s accurate and supported by the research evidence, that’s pretty much what people always think.

This is what I discussed in a previous post, where I promised to write some followups about specific examples of this sort of thing. So here we go!

Beauty is a good example of shifting cultural attitudes—not only in the sense that beauty standards have changed over the decades, but also in terms of what meaning and significance we attribute to beauty as a quality. In her book The Body Project: An Intimate History of American Girls, Joan Jacobs Brumberg discusses these shifting meanings. Brumberg notes in her chapter on skincare that in the 19th century, acne and other facial blemishes were considered a sign of moral or spiritual impurity. In fact, many people believed that people got blemishes as a result of masturbating, having “promiscuous” sex, or simply having “impure” thoughts. She writes, “In the nineteenth century, young women were commonly taught that the face was a ‘window on the soul’ and that facial blemishes indicated a life that was out of balance.”

By the mid-20th century, however, Americans had already started to think of beauty very differently. Brumberg writes of perceptions of acne in the postwar period:

Although acne did not kill, it could ruin a young person’s life. By undermining self-confidence and creating extreme psychological distress, acne could generate a breakdown in social functioning. Acne was considered dangerous because it could foster an “inferiority complex,” an idea that began to achieve wide popularity among educated Americans.

Facial blemishes were no longer considered a sign of inner weakness or impurity; they were a potentially dangerous blow to a young person’s self-esteem. They were something to be dealt with swiftly, before they could cause any serious damage:

In magazines popular with the educated middle class, parents were urged to monitor teenagers’ complexions and to take a teenager to a dermatologist as soon as any eruptions appeared: “Even the mildest attack is best dealt with under the guidance of an understanding medical counselor.” Those parents who took a more acquiescent view were guilty of neglect: “Ignoring acne or depending upon its being outgrown is foolish, almost wicked.”

Whereas worrying about one’s appearance and trying to correct it was once viewed as improper for young women, it was now considered acceptable and even productive. Even state health departments issues pamphlets urging young people to make sure that they are “as attractive as nature intended you to be.” It was understood that beauty was an important and necessary quality to have, not only because it opened doors for people but because it was just another aspect of health and wellbeing.

Today, our views on beauty seem much more rife with contradictions. Obviously beauty is still important. Women (and, to a lesser but growing extent, men) are still encouraged and expected to spend money, time, and energy on improving their appearance. We know from research that the halo effect exists, and that lends a certain practicality to what was once viewed as a frivolous pursuit—trying to be beautiful.

At the same time, though, we insist that beauty “doesn’t matter,” that “it’s what’s on the inside that counts.” It’s difficult for me to imagine a modern middle-class parent immediately rushing their child to the dermatologist at the first sign of pimples; it seems that they would be more likely to encourage the child to remember that “beauty is only skin deep” and that one’s “real friends” would never make fun of them for their acne. (Of course, I grew up with no-nonsense immigrant parents who rejected most forms of conformity, so maybe my experience was different.) Nowadays, costly medical interventions to improve teenagers’ looks are more associated with the upper class than the middle class, and we tend to poke fun (or shudder in disgust) at parents who take their children to get plastic surgery and put them on expensive weight loss programs.

It appears that our culture has outwardly rejected—or is in the process of trying to reject, amid much cognitive dissonance—the idea that beauty is a good way to judge people, that it reveals anything about them other than how they happen to look thanks to genetics or their environment. No longer do we consider beauty a sign of purity and spiritual wellbeing, as in the Victorian era, or of health and social success, as in the postwar years.

Of course, that’s just outwardly. Although we’re loath to admit it, beauty still matters, and people still judge others by their appearance, and we still subscribe to the notion that anyone can be beautiful if they just try hard enough (which generally involves investing a sufficient amount of money). While people are likely to tell you that beauty is a superficial thing that shouldn’t matter, their actions suggest otherwise.

An interesting contrast to this is Brazil, where plastic surgery, or plástica, is generally covered by the state healthcare system. As anthropologist Alexander Edmonds describes, many in Brazil believe that beauty is a “right” that everyone deserves, not just those who can afford it. One surgeon says:

In the past the public health system only paid for reconstructive surgery. And surgeons thought cosmetic operations were vanity. But plástica has psychological effects, for the poor as well as the rich. We were able to show this and so it was gradually accepted as having a social purpose. We operate on the poor who have the chance to improve their appearance and it’s a necessity not a vanity.

Brazilians, too, have been influenced by Alfred Adler’s concept of the “inferiority complex,” and in this sense the meaning of beauty in that context is similar to that in postwar America, although with a few differences. Like Americans in the 1950s, many Brazilians believe that improving one’s appearance is an important form of healthcare that heightens self-esteem and confidence. It’s not a matter of vanity.

However, unlike Americans, Brazilians (at least the ones profiled in Edmonds’ study) believe that self-esteem is important for the poor as well as for those who are better-off. In the United States people tend to scoff at the idea that people living in poverty need (let alone deserve) entertainment, pleasure, or really anything other than what they need to survive, and in the postwar years the focus on adolescents’ appearance seemed to be confined to the middle and upper class. But in Brazil it’s accepted as a “right”–a right to be beautiful.

Looking at how Americans in the past viewed beauty, as well as how people in other cultures view it, exposes the contradictions in our own thinking about it. Our outward dismissal of beauty as vain and unimportant clashes with our actual behavior, which suggests that beauty is quite important. This tension probably emerged because we have abandoned our earlier justifications for valuing beauty, such as the Victorian view of beauty as a sign of morality and the postwar view of beauty as a vital component of health. Now that we know that beauty has nothing to do with morality and relatively little to do with health, we’re forced to declare that it “doesn’t matter.” But, of course, it does.

You may be as straight as an arrow, and you may have a friend that is as straight as an arrow. Say you had a great job with the government where you had this wonderful health plan. I mean, what would prohibit you from saying that you’re gay, and y’all get married and still live as separate, but you get all the benefits? I just see so much abuse in this it’s unreal. I believe a husband and a wife should be a man and a woman, the benefits should be for a man and a woman. There is no way that this is about equality. To me, it’s all about a free ride.

Sometimes people just come so close to the source of the problem but then still manage to veer off into complete idiocy.

Of course there would be same-sex couples who’d get married just for the benefits if same-sex marriage were legal where they live. There are already straight couples who do that. Hasn’t Everhart ever seen The Proposal? (Ignoring the part where they totally unrealistically fall in love, that is, because romcom.) And couldn’t gay men and lesbians just marry each other for the benefits, too?

Perhaps Everhart lives in a fantasy land in which people are only friends with others of the same gender, meaning that legalized same-sex marriage would indeed make it easier for people to shack up just for the benefits. But that’s not really how friendship works, especially since the need for healthcare and green cards goes beyond gender.

The truth that Everhart came so close to but still managed to completely miss is that federal benefits for married couples are fundamentally unfair. Why should having a certain type of relationship entitle you to special prizes? And don’t give me that crap about promoting procreation; we already heard it last week in the Supreme Court arguments. First of all, we give married couples those benefits even when no procreation is reasonably going to happen, and second, if you really believe that what this world most desperately needs are additional humans, I feel sad for you.

Everhart clearly thinks that marrying “for the benefits” is the wrong reason to get married. But what’s the right reason? Because one of you got pregnant and abortion is wrong? Because you need someone to provide for you (or take care of your household)? Because your families want to exchange property? Because you “truly” love each other and not just “as friends,” whatever that means?

Assuming that getting married “for the benefits” is Bad, well, that’s the problem when the government chooses to incentivize certain kinds of human relationships with material benefits, and when health care is only available to those who are given insurance by their employer, who can afford to buy insurance or pay for healthcare out of pocket, or who can marry someone to get on their insurance plan. Why should you only have that “wonderful health plan” of which Everhart speaks if you happen to have the right employer or be married to the right person? None of these things should be tied to marriage. But if they’re going to be, it’s only fair that same-sex couples have access to them, too.

Cultural phenomena like marriage are constantly changing in meaning and purpose. It used to be that most marriages were essentially “for the benefits”–for the husband’s family to get a dowry and carry on their family name, for the wife’s family to get the bride price, for the wife to have financial support, for the husband to have a housewife and a source of sexual gratification, for both families to receive social advantages of some sort, and so on. So, either Everhart should condemn all forms of marriage-for-benefits, or she should acknowledge that it only bothers her when the gays do it.

Conveniently, she basically did just that: “Lord, I’m going to get in trouble over this, but it is not natural for two women or two men to be married. If it was natural, they would have the equipment to have a sexual relationship.”

All I can say to that is that I truly feel sorry for Everhart if she really thinks that P-in-V is the only way to have sex.

For your reference. I’ll try to update this as needed. Read the linked articles for more information about these bills and why they are so harmful.

Oklahoma State Bill 1433–defines a fertilized egg as a “person” and seeks to extend human rights to said “persons”; conflicts with Roe v. Wade.

Georgia House Bill 954–bans all abortions after 20 weeks, even in cases of rape and incest, unless the woman’s life or health was threatened (this last exception was only added later); also conflicts with Roe v. Wade; this is the bill that a George state rep defended by comparing women to lifestock.

Arizona House Bill 2036–bans all abortions after 20 weeks because, according to lawmakers, that’s when fetuses begin to feel pain (which is false); conflicts with Roe v. Wade; defines fetal age as beginning at fertilization–up to two weeks before a woman’s last period, which is how fetal age is usually calculated. So really, it’s after 18 weeks, not after 20 weeks like the other dumb bills.

Mississippi Senate Bill 2771—would make all abortions performed after a fetal heartbeat can be detected illegal; doctors who perform such abortions could serve up to 30 years in prison. Women seeking abortions would be forced to undergo an invasive transvaginal ultrasound to check for a heartbeat, which can be detected just 6 weeks after gestation.

Alabama Senate Bill 12–would have mandated all women seeking abortions, even victims of rape and incest, to undergo a transvaginal ultrasound and view the image. Why? To help “a mother to understand that a live baby is inside her body.”

Virginia House Bill 62–slashes state funding for low-income women who are pregnant with complications and need abortions.

Arizona Senate Bill 1359–allows doctors to withhold information from pregnant women that may cause them to seek an abortion (such as fetal abnormalities) by shielding them from potential lawsuits.

One note–I’ve chosen not to attempt to find updated information on how these bills did in HRs and Senates, first of all because that would take all of my time, and second because that’s not the point. Some of these bills passed, some of them are still being deliberated. Point is, none of them should’ve made it onto the floor to begin with.

Another note–I stopped writing this post not because I was unable to find any more bills, but because I just got tired and sad from looking at them.

Up until this week, those of us with a shred of optimism and/or naivete could have pretended that the difference between liberals’ and conservatives’ perspectives on birth control were due to something as benign as “differing beliefs.”

However, now that Rush Limbaugh has run his mouth on the subject, I think we can all agree that much of the conservative opposition to birth control is due not to differing beliefs that are equally legitimate and should be respected, but to simple, stupid ignorance.

The following is probably common knowledge now, but I’ll rehash it anyway:

Sandra Fluke, a 31-year-old Georgetown University law student, was proposed by the Democrats as a witness in the upcoming Congressional hearings on birth control. Her history of feminist activism and her previous employment with a nonprofit that advocated for victims of domestic violence made her an appropriate witness for their side.

Representative Darrell Issa (R-CA), the chairman of the House Committee on Oversight and Government Reform, turned her down because, he claimed, her name had been submitted too late.

The resulting panel of witnesses for the Congressional hearings turned out to consist of absolutely no women whatsoever, which is really funny in that not-actually-funny-way because hormonal birth control of the sort whose mandated insurance coverage was being debated is only used by women/people with female reproductive systems.

A week later, she testified for House Democrats, mentioning that birth control would cost her $3,000 over three years. Lest anyone misinterpret her argument as being solely about those slutty women’s desire to have tons and tons of sex, she also mentioned her friend with polycystic ovary syndrome who developed a cyst because she was denied coverage for birth control pills (which would’ve helped because they would’ve reinstated a regular menstrual cycle).

A few days later, Rush Limbaugh decided to insert his expert opinion into the discourse surrounding mandated insurance coverage of birth control. His expert opinion?

What does it say about the college coed Susan Fluke [sic], who goes before a congressional committee and essentially says that she must be paid to have sex? What does that make her? It makes her a slut, right? It makes her a prostitute. She wants to be paid to have sex.

The next day, he clarified his views:

So, Ms. Fluke and the rest of you feminazis, here’s the deal. If we are going to pay for your contraceptives, and thus pay for you to have sex, we want something for it, and I’ll tell you what it is. We want you to post the videos online so we can all watch.

And the next day (allow me to shamelessly quote Wikipedia):

The following day Limbaugh said that Fluke had boyfriends “lined up around the block.”[18] He went on to say that if his daughter had testified that “she’s having so much sex she can’t pay for it and wants a new welfare program to pay for it,” he’d be “embarrassed” and “disconnect the phone,” “go into hiding,” and “hope the media didn’t find me.”[19]

I’m not going to waste anyone’s time by explaining how misogynistic Limbaugh’s comments were, especially since plenty of excellent writers have done so already. However, it continually shocks me how he gets away with saying things that are not only offensive and inflammatory, but simply inaccurate.

First of all, a primer for anyone who’s still confused: except for barrier-based forms of birth control (i.e. condoms and diaphragms), the amount of birth control that one needs does not depend on how much sex one is having. Hormonal birth control works by preventing ovulation, and in order for it to work, it has to be taken regularly and continually. For instance, you take the Pill every day, or you apply a new patch every week, or you get a new NuvaRing each month, or you get a new Depo-Provera shot every three months. You stick to this schedule whether you’re having sex once a week or once a day or ten times a day. You stick to it if you’re having sex only with your husband, and you stick to it if you’re having sex with several fuck buddies, and you stick to it if you’re a prostitute and have sex with dozens of different people every day.

Therefore, when Limbaugh says that those who support mandated insurance coverage of birth control are “having so much sex [they] can’t pay for it,” he’s not merely being an asshole. He’s also simply wrong.

And for the record, he didn’t even get her name right. It’s Sandra, not Susan. One word of advice for you, Limbaugh: if you’re going to call someone a slut and a prostitute, at least use their correct name. But I guess we should give him credit for knowing which letter it starts with.

I don’t care what your views are on mandated insurance coverage of birth control. I don’t care what your views are on how much or what kind of sex women should be allowed to have (as much as they want and whichever kind they want, in my opinion). Because whatever your views are on these things, you have to agree that these questions should not be getting answered by people who have absolutely no understanding of how these things actually work.

For instance, Limbaugh completely ignored the part of Fluke’s testimony in which she described the problem faced by her friend with polycystic ovary syndrome. This friend’s predicament has nothing to do with sex. Absolutely nothing. For all we know, she’s a virgin.

After all, polycystic ovary syndrome isn’t caused by anything that involves sex. The current medical opinion is that it’s probably caused by genetics.

Unlike some feminists, I don’t think that men should be excluded from debates about women’s health. But men (and women) who show little or no understanding about women’s health should absolutely be excluded from these debates.

You wouldn’t let a doctor who believes that babies come from storks deliver your baby. You wouldn’t let a mechanic who doesn’t know how an engine works work on your car. And you shouldn’t let politicians and commentators who think that you need more birth control if you have more sex decide whether or not birth control will be covered by your insurance.

And, for the record, I also don’t think that Congressional hearings on birth control should look like this:

I’m going to come out of my cave and write about something that pisses me off. (OK, so I could start any blog post this way, but whatever.)

Here’s something that I consider one of the most glaring cultural problems in America today–it’s the idea that just because something is difficult, it is impossible and not worth trying. Our culture has become a deeply pessimistic one, and the message that it sends these days is “Oh, forget it, we could never change that anyway.”

Don’t believe me? Well, you should, because I’m right. There’s a reason that the issues that land on the political agenda are fairly simple–go to war, or not go to war. Allow gay marriage, or not allow gay marriage. Raise the debt ceiling, or don’t raise it.

Don’t get me wrong, I’m not saying these issues aren’t fraught with difficulties of their own. But they are very simple–yes or no. Right or wrong. Do, or don’t.

The issues that don’t really get talked about much are the complex ones. How to fix our education system. How to achieve equality between women and men, and between whites and people of color. How to create a more just and sustainable food system. How to end our addiction to oil. How to end the Israeli/Palestinian conflict. How to encourage democracy to take root in other parts of the world without shoving it down people’s throats.

To be sure, our government does things to try and ameliorate these issues somewhat, but they’re always band-aid solutions to broken-bone problems. For instance, George W. Bush tried to “fix” our schools with No Child Left Behind. President Obama issued empty threats to Israeli Prime Minister Netanyahu to stop settlement building, with no regard for the religious and political complexities that the settlement issue dredges up. Then there’s that little Iraq thing. As for our screwed-up food system, racial justice, and ditching the oil habit, I don’t think anything’s being done at all.

Try coming up to an older person (by which I mean, someone old enough to have their own kids) and talking to them about these issues. About education, about food, about the racism still embedded deep within our society. Ten bucks says they tell you something like, “Yeah, it’d be great if that could get fixed, but face it–it’s never gonna happen.”

Why? Why the hell not?

Well, because it’s hard.

People think that these things are never gonna get fixed because it’s so hard to fix them. And by hard, I mean like when you’re trying to do a math problem and you don’t even know where to start. You’re completely stuck. Nothing you’ve ever learned is going to help you here.

The stuff that gets in the news, like gay marriage, the debt ceiling, and all of that sort of stuff, is different from these issues because, despite our disagreement on them, we know what to do. We either vote yes, or no. But you can’t vote “yes” or “no” on education reform or on ending racism, because you have to figure out what the hell to actually do about it.

Note what a clusterfuck occurs when our government actually tries to take on a complex and nuanced issue–for instance, healthcare reform. It nearly stops functioning. Our culture is terrified of complexity.

Usually when young people like me talk about fixing some of these complicated problems, older people call us “idealists.” (And that’s at best–sometimes they use less charitable labels.) To me, all that’s saying is that we’re willing to think about and talk about things that are hard, and “realistic” people are not.

Well, realism is dooming this country. Realists are people who don’t think we can stop global warming, who don’t think we can have just and efficient healthcare, education, and food systems, who don’t think we can ever achieve equality between sexes, races, socioeconomic classes, or sexual orientations.

And guess what? If you tell yourself you can’t do something, it’s not going to get done.

And anyway, isn’t that a terribly demoralizing thing to say? I think we’re selling ourselves short when we say that we can’t solve complex problems like these. After all, the human race invented democracy, finance and agriculture, created the Mona Lisa, painted the Sistine Chapel, put a man on the moon, eradicated polio, and set up the Internet. Do our accomplishments really end there?

Just because something is difficult does not mean it’s impossible. Things that are impossible, at least with our current knowledge and technology, are traveling through time, sprouting wings and flying, curing cancer, and turning lead into gold. But things that are merely difficult? Well, that’s just about everything else.

Discrimination against fat people is a problem. People who are overweight are often judged to be less competent, less intelligent, and more lazy–not to mention less attractive–than people who are of a “normal” weight. They face discrimination in the workplace, and there are some jobs for which they are unlikely to ever be hired at all.

It’s only natural, then, that a movement has sprung up to combat “fatism”–and that’s awesome. What bothers me, however, is the tendency of anti-fatism activists to deny the fact that being severely overweight has negative effects on one’s health. I hear a lot of “weight has nothing to do with health” arguments these days, and this sort of denialism is simply dangerous. Obesity is a problem in America, and it does put you at increased risk for a lot of health problems, such as:

Regardless, denying these health problems does not help anyone, and admitting that being obese is unhealthy is not tantamount to justifying discrimination against obese individuals. After all, one’s health is one’s own business, and not taking care of your body shouldn’t result in being discriminated against.

It worries me when social movements respond to a problem in society (such as fatism) by taking the extreme opposite view. This happens a lot with progressives. For instance, noticing that our society has pervasive and restrictive gender roles, some claim that gender is entirely socially constructed and has no basis in biology whatsoever. (Apparently these people never noticed that men and women do actually have at least one very noticeable biological difference.) Some note that homophobia is rampant in society, so they insist that heterosexuality is actually constructed and unnatural, and that same-sex relations are the only “genuine” ones. Similarly, some people think that because discrimination against fat people exists and discrimination is wrong, therefore, there is nothing whatsoever bad or unhealthy or in any way undesirable about being overweight.

But being fat isn’t the same as being part of other marginalized groups, such as being a woman, being gay, being transgender, or being Black. No reputable scientific study has ever found that being gay or transgender is in any way unhealthy or abnormal (except, of course, in the statistical sense). No reputable scientific study has ever found that women or African Americans are inferior in any way to men or Caucasians. But our entire body of medical evidence shows that being severely overweight comes with significant hazards to your health. This is something that is simply true. Regardless of whether you think BMI is a good measure of obesity, and regardless of how easy or difficult it is for you to lose weight, being obese is unhealthy. Does this mean that discrimination against fat people is okay? Hell no. But it does mean that obesity is something that should be discouraged.

Incidentally, some of the things that anti-fatism activists consider discrimination simply aren’t. For instance, when airlines ask obese people to buy two seats, guess what–it’s not because they just don’t like obese people. It’s because if your body requires more than one seat, then you should have more than one seat–in which case, it follows that you should pay for more than one seat, because it wouldn’t be fair to give some people a second seat for free. Furthermore, it would be unfair for a person who paid for a seat to effectively receive only half a seat because the person sitting next to them clearly requires part of theirs. Does it suck to have to pay more to fly if you’re fat? Yes. But in that case, lobby for airlines to make seats bigger, not to give you permission to use half of another customer’s seat.

Also, companies that provide incentives for their employees to exercise/get down to a healthy weight/whatever are not being fatist. They’re doing two things: 1) encouraging their employees to be healthier, and 2) saving themselves money by reducing lost productivity due to medical problems and by reducing the amount they have to pay as insurance. Fact: being healthier and not obese reduces medical expenditures. Similarly, doctors who recommend that their obese patients lose weight are not being fatist. They are being doctors. I am terrified of the day when doctors are prevented from dispensing sound, evidence-based medical advice for fear of offending someone.

Regardless, it is, in fact, quite possible to discourage obesity without promoting eating disorders, obsessive dieting and exercising, and holding oneself to an impossible standard of beauty, as the mass media does. Conflating efforts to discourage obesity with efforts to promote unhealthy behaviors or stigmatize fat people is intellectually lazy. There is, for every issue, a solution that is healthy, reasonable, and benefits the greatest possible number of people. Just because that solution is extremely hard to find doesn’t mean it doesn’t exist. It’s there, and I can guarantee that it is almost never at one extreme or the other. It’s usually somewhere in the middle.